title: Exploring nursing assistants' roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study.
abstract: OBJECTIVE
  To explore nursing assistants' roles during the actual process of pain management (assessment, reporting, implementation of pain-relieving interventions and re-assessment) for cognitively impaired home residents with pain.
  
  
  BACKGROUND
  Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents' pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants' functions in pain management.
  
  
  METHODS
  This is a descriptive, exploratory qualitative study.
  
  
  METHODS
  Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis.
  
  
  RESULTS
  Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions.
  
  
  CONCLUSIONS
  This study highlights the importance of nursing assistants in successful pain assessment and identifies their possible supporting roles in other aspects of pain management. However, nursing assistants' scope of practice resulted in their functions in pain management being continually undervalued by other healthcare professionals. Continuous in-service training, the use of a standardized pain management protocol and strategies for building coherent work teams in nursing homes are suggested to improve this situation.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
authors.forename: Justina Y W
authors.initials: JY
authors.lastname: Liu
mesh_terms: D003072:Cognition Disorders / Q000150:complications*; D006801:Humans; D007297:Inpatients; D009728:Nursing Assistants; D009735:Nursing Homes; D059408:Pain Management; D036301:Qualitative Research
keywords: ageing; behavioural observation; cognitive impairment; nursing assistants; nursing homes; pain assessment; pain management